Provider Demographics
NPI:1538655113
Name:MANCINI, KENDRA NICOLE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:NICOLE
Last Name:MANCINI
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:NICOLE
Other - Last Name:LANZEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3583 HOGAN CIR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5085
Mailing Address - Country:US
Mailing Address - Phone:248-770-9920
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2689
Practice Address - Country:US
Practice Address - Phone:313-916-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276096363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care